Permit y CITY OF TIGARD PLUMBING PERMIT
. DEVELOPMENT SERVICES PERMIT #: PLM2001 -00151
s :�_ DATE ISSUED: 7/30/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -41 r1
SITE ADDRESS: S 7 vd cj - 2/21)A ' PARCEL: 2S114A0 -01500
SUBDIVISION: 0 0
�'� ZONING: R -12
BLOCK: LOT: JURISDICTION: TIG
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES: 1
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: NONE FLOOR DRAINS: TRAPS:
STORIES: WATER HEATERS: CATCH BASINS:
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 137 ft
WATER CLOSETS: WATER LINE: 800 ft
DISHWASHERS: RAIN DRAIN: 380 ft
Remarks: Site utilities associated with Cook Park expansion.
FEES
Owner:
Type By Date - Amount Receipt
TIGARD, CITY OF
13125 SW HALL
TIGARD, OR 97223 Total .
Phone 1:
Contractor:
NORTHWEST EARTHMOVERS INC
PO BOX 1467
TUALATIN, OR 97062 REQUIRED INSPECTIONS
Phone 1: 503 - 624 -0363 Sewer Inspection
Water Line Insp
Reg #: LIC 62761
Storm Drain Insp
Final Inspection
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR.
Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans.
This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more
than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth in OAR 952 - 0001 -0010 through OAR 952- 0001 -0080.
You may obtain copies of these rules or direct questions to OUNC by calling (503) 246 -1987.
, �. , /
Issue By: i� `� �1 ,,� _ • �j� `/ Permi tte e Signature: ?;
Call (503) 639 -4175 by 7:00 P.M. for an inspection needed the ne . usiness day(
�,,�
—S GL 77 / T/
Plumbing Permit Application
Date received: ' �® Permit no.: / —a0 /51
41, f � � ; City of Tigard
i Sewer permit no.: Building permit no.:
+ - Address: 13125 SW Hall Blvd, Tigard, OR 97223
City of Tigard Phone: (503) 639 -4171 Project/appl.no.: Expire date:
n � t .El'" Fax: (503) 598-1960 Date issued: By: Receipt no.:
t� Land use approval: C(,( PaOc -0000 / Case file no.: Payment type:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family 0 Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Food service 0 Other:
JOB SITE INFORMATION , FEE SCHEDULE (for special information use checklist)
Job address: ( K p,,, - ?p1 , Description Qty. Fee (ea.) Total
Bldg. no.: Suite no.: New 1- and 2- family dwellings only:
(includes 100 ft. for each utility connection)
Tax map /tax lot/account no.: SFR (1) bath
Lot: (Block: ( Subdivision: SFR (2) bath
Project name: Cam- PA-eK. Q ,e- .- SFR (3) bath
City /county: ( ZIP: Each additional bath/kitchen
Description and location of work on premises:. Site utilities:
' 7 uk. L,t-(-1 Catch basin/area drain
Est. date of completion/inspection: Drywells/leach line/trench drain
' PLUMBING CONTRACTOR 'r Footing drain (no. lin. ft.)
_ Manufactured home utilities
Business name: ` i 1) Manholes
Address: Rain drain connector
City: 'State: (ZIP: Sanitary sewer (no. lin. ft.) t3Z
Phone: Fax: (E -mail: Storm sewer (no. lin. ft.)
Water service (no. lin. ft.) boa
CCB no.: ( Plumb. bus. reg. no:
City /metro lic. no.: Fixture or item:
Contractor's representative signature: Absorption valve
Back flow preventer
Print name: - Date: Backwater valve
CONTACT PERSON Basins/lavatory
Name: Clothes washer
•
Dishwasher
Address: Drinking fountain(s) .
City: ( State: ( ZIP: Ejectors/sump
Phone: Fax: E -mail: Expansion tank
OWNER Fixture/sewer cap
Floor drains/floor sinks/hub
Name (print): a � ak — r76.4t -6 Garbage disposal
Mailing address: • 1 2, t 25 Sc,3 I.kiku. GU.) h Hose bibb
City: . �' (State: i? ( ZIP: c t7 2.Z3 Ice maker _
Phone: (off , (1 ( ( Fax: (E -mail: Interceptor /grease trap
Owner installation/residential maintenance only: The actual installation Primer(s)
will be made by me or the maintenance and repair made by my regular Roof drain (commercial)
employee on the property I own as r ORS Chapter 44 7. Sink(s), basin(s), lays(s)
Owner's signatur Date: /.3 D7 Sump
Tubs/shower /shower pan -
Name: � 4 113 Urinal
Water closet
Address: l SS-13 SW -300 Water heater
City: L, F_ Or,uJ£br-o ( tate: o e 'ZIP: Q 7 pZT Other:
Phone: Cita _ (,G,QS ( Fax: (E -mail: Total -
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Minimum fee $
Notice: This permit application Plan review (at _ %) $
❑ Visa ❑ MasterCard expires if a permit is not obtained
Credit card number: / / State surcharge (8 %) .... $
Expires within 180 days after it has been
TOTAL $
Name of cardholder as shown on credit card
. accepted as complete.
_ $
Cardholder signature Amount 440 -4616 (6/00/COM)
PLUMBING PERMIT FEES: • " ,•.
' ,. , .;, r 0 nds2- fampsf- dweliin i onI `4 , . r >;' rr .,� Y . , �,.. y • fl;. ° ;��� ��~. �, ��.:11-14-M ���,w`st - -�, � ,�P.. RICE�= ,,TOTAL New 7 a Y..a,t 9 Y � � � � �f
t } " R ' w 7 , i a `" - `"` A incIuudes °81i' IUm6tn "it res it ` ^` ', PRICE .:TOTAL
FIXTU,RES.�,(individtial)�,���s �- .;��a:;; z -su��. �QTY.a .��,(ea)r .._ ,AMOUNT ,� �:( :,,,, " � p �,� .� e 9� f �« T 1( � a ` � j' AMO
Sink 16.60 `;the dwe ing and #1 fi ft ` . Q ti (e) UNT s
£`,for eachf utiii connection " = i ' 4 ;
16.60 a��. - a . " ;,...��.�,�; =�
Lavatory One (1) bath ) $249.20
Tub or Tub /Shower Comb. 16.60 Two (2) bath $350.00
Shower Only 16.60 Three (3) bath $399.00
Water Closet 16.60 SUBTOTAL f -'_` ..:".i L
16.60 '" o:';
Urinal 8% SURCHARGE £= ?�a ° �? :� -�_ ,v
Dishwasher 16.60 PLAN REVIEW 25% OF SUBTOTAL ,f :_'"" , "' 'a. ..°.
Garbage Disposal 16.60 TOTAL ` , : -, :, `_. '
Laundry Tray 16.60
Washing Machine 16.60
Floor Drain /Floor Sink 2" 16.60 PLEASE COMPLETE:
3" 16.60
4" 16.60 •
r Quantity by Work Performed
Water Heater 0 conversion 0 like kind 16.60 New a Moved Re laced Re ;
Gas piping requires a separate mechanical ire ;T t r, 5 R . p, ,.d ; , -5,.-d e d'
permit. �.. „� PP
MFG Home New Water Service • 46.40 Sink
MFG Home New San/Storm Sewer 46.40 Lavatory _
Tub or Tub /Shower •
Hose Bibs 16 ' Combination
Roof Drains 16.60 _Shower Only .
Drinking Fountain 16.60 Water Closet
16.60 _Urinal _
Other Fixtures (Specify) Dishwasher
Garbage Disposal
Laundry Room Tray
• • Washing Machine
Floor Drain /Sink: 2" _
Sewer - 1st 100' 55.00 - 3"
Sewer - each additional 100' 46.40 4" __
Water Service - 1st 100' 55.00 _Water Heater ._
46.40 Other Fixtures
Water Service - each additional 200' (Specify)
Storm & Rain Drain - 1st 100' 55.00
Storm & Rain Drain - each additional 100' 46.40
Commercial Back Flow Prevention Device 46.40
Residential Backflow Prevention Device* 27.55
Catch Basin 16.60 -
Inspection of Existing Plumbing or Specially 72.50
Requested Inspections per/hr COMMENTS REGARDING ABOVE: •
Rain Drain, single family dwelling 65.25 . ..
Grease Traps 16.60 •
QUANTITY TOTAL -° ' ',: ., 4 ; ° ^, .: .. •
Isometric or riser diagram is required if r €; . :4„ f= ,, } :n i
Quantity Total is > 9 ;, 9n - >:„ '
*SUBTOTAL re.; e4, ';f x "" s
8% STATE SURCHARGE " _," ,�;' ':�' *> °. .
• **PLAN REVIEW 25% OF SUBTOTAL ? = a >'''
Required only if fixture qty. total is > 9 ,` % , ✓ ; ^ .t. ,
TOTAL h ;,.ttyr -`, 7,,,g;,;,--":72 $ • ,
* Minimum permit fee is $72.50 + 8% state surcharge, except Residential Backflow
Prevention Device, which is $36.25 + 8% state surcharge.
** All New Commercial Buildings require plans with isometric or riser diagram and
plan review.
i:\dsts \forms\plm - fees.doc 10/10/00
- - • CITY OF TIGARD BUILDING INSPECTION DIVISION
MST
24 -Hour Inspection Line: 639 -4175 Business Line: 639 -4171
BUP
Date Requested " /d v AM PM • BLD
Location 17 00 s' e ,r d ,4 Suite MEC
Contact Person Ph Y q .5 (Oe (c.c
Contractor . Ph SWR
BUILDING ° Tenant/Owner�� ELC
Retaining Wall ELR
Footing Access:
Foundation FPS
Ftg Drain SGN
Crawl Drain Inspection Note s
i
Slab - �
SIT
Post & Beam ' � ? ,
-
Ext Sheath /Shear
Int Sheath /Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
M isc:
- 4
Final
PASS PART FAIL
-
PLUMBING
Post & Beam
Under Slab
Top Out
Water Service
Sanitary Sewer
• rains
ASS ART FAIL
CHANICAL_
Post & Beam
Rough In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
ELECTRICAL -`
Service
Rough In
UG /Slab
Low Voltage
Fire Alarm
Final
PASS PART FAIL
SITE °
Backfill /Grading
Sanitary Sewer
• Storm Drain [ ] Reinspection fee of $ required before next inspection. Pay at City Hail, 13125 SW Hall Blvd
Catch Basin
Fire Supply Line [ ] Please call for reinspection RE: [ ] Unable to inspect - no access
ADA
Approach /Sidewalk /6 -30 -0/ X � l '
Other Date Inspector � ��`�: Ext
Final
PASS PART FAIL DO NOT REMOVE this inspection record from the job site.